Provider Demographics
NPI:1720258536
Name:STAR MEDICAL PRODUCTS, INC
Entity type:Organization
Organization Name:STAR MEDICAL PRODUCTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRIGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GURDOGGHLUYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-760-0662
Mailing Address - Street 1:12455 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4519
Mailing Address - Country:US
Mailing Address - Phone:818-760-0662
Mailing Address - Fax:
Practice Address - Street 1:12455 OXNARD ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4519
Practice Address - Country:US
Practice Address - Phone:818-760-0662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6146770001Medicare NSC